JUDITH M. MASCOLO, MD, LLC (NPI# 1043406812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043406812 |
| Entity Type | Organization |
| Organization Name | JUDITH M. MASCOLO, MD, LLC |
| Practice Address |
639 Park Rd Ste 100 West Hartford CT 06107-3443 |
| Mailing Address |
639 Park Rd Ste 100 West Hartford CT 06107-3443 |
| Practice Telephone | 8602334600 |
| Practice Fax Number | 8602334604 |
| Mailing Telephone | 8602334600 |
| Mailing Fax Number | 8602334604 |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2014-04-28 |
| Authorized Official Name | DR. JUDITH M MASCOLO (OWNER) |
| Authorized Official Telephone | 8602334600 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036592 | CT | Allopathic & Osteopathic Physicians |
| Street Address |
639 PARK RD STE 100 |
| City | WEST HARTFORD |
| State | CT |
| Zip Code | 06107-3443 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407878754 | Patrick F Albergo | Specialist | 639 Park Rd, Suite #100, West Hartford, CT 06107-3443 | 2006-07-24 |
| 1275781122 | Desmond Walter Ebanks | Internal Medicine | 639 Park Rd, 2nd Floor, West Hartford, CT 06107-3443 | 2008-09-04 |
| 1316166788 | Karen Diane Caffrey | Counselor | 639 Park Rd, West Hartford, CT 06107-3443 | 2007-04-24 |
| 1215057435 | Connecticut Eye Center, P.C. | Ophthalmology | 639 Park Rd, Suite #100, West Hartford, CT 06107-3443 | 2007-03-30 |
| 1972641801 | Judith M Mascolo | Family Medicine | 639 Park Rd, Suite 100, West Hartford, CT 06107-3443 | 2007-02-02 |
| 1477654838 | Duane F Austin | Ophthalmology | 639 Park Rd, Suite #100, West Hartford, CT 06107-3443 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538783659 | Briana Deslauriers | Audiologist | Solinsky Hearing Center, 1013 Farmington Avenue, West Hartford, CT 06107 | 2020-06-04 |
| 1750851366 | Candyce Yvonne Scott | Counselor | 61 S Main St Ste 310, West Hartford, CT 06107 | 2018-11-27 |
| 1124524798 | Image of Light Mental Health Services, LLC | Nurse Practitioner | 45 S Main St Ste 70, West Hartford, CT 06107 | 2018-04-03 |
| 1235632498 | Leila Fussell | Student in an Organized Health Care Education/Training Program | 175 Garfield Rd, West Hartford, CT 06107 | 2018-03-14 |
| 1568818169 | Gail Southard Canzano | Psychologist | 81 S. Main St, West Hartford, CT 06107 | 2016-05-12 |
| 1922470939 | Optimal Wellness of West Hartford | Family Medicine | 1001 Farmington Ave., West Hartford, CT 06107 | 2015-10-29 |
| 1518369925 | Maria Eugenia Garcia-ayala | Psychiatry & Neurology | 65 Memorial Rd Ste 508, West Hartford, CT 06107 | 2014-09-17 |
| 1376884981 | Robert Moss | Pediatrics | 174 Wood Pond Road, West Hartford, CT 06107 | 2013-03-06 |
| 1659630960 | Michael John Grille | Anesthesiology | 65 Memorial Rd #435, Hartford Hospital Pain Treatment Center, West Hartford, CT 06107 | 2012-05-07 |
| 1518268010 | Parsons Health Co. Inc | Legal Medicine | 61 So Main Street, Suite 202, West Hartford, CT 06107 | 2010-11-15 |
| Find all providers in zip 06107 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891278529 | Viktoriya Anatolievna Stork | Family Medicine | 35 Danforth Ln, West Hartford, CT 06110-2436 | 2018-09-10 |
| 1780958058 | Srinivasulu Conjeevaram | Family Medicine | 11 Winthrop Rd, Apt 2a, West Hartford, CT 06110-1656 | 2012-03-02 |
| 1588815054 | Marc T Edwards | Family Medicine | 111 Hunter Dr, West Hartford, CT 06107-1018 | 2008-10-02 |
| 1811919202 | Jay Donald Smith | Family Medicine | 11 W Ridge Dr, West Hartford, CT 06117-2047 | 2006-07-24 |
| 1811964752 | Steven W Luger | Family Medicine | 37 Miamis Road, West Hartford, CT 06117-5719 | 2006-02-28 |
| 1588661813 | Jesse Samuels | Family Medicine | 25 Cascade Rd, West Hartford, CT 06117-2006 | 2005-07-01 |
| 1306840640 | Jeffrey R Brown | Family Medicine | 445 South Main Street, West Hartford, CT 06110 | 2005-06-02 |
| 1407267214 | Florence Jaffa | Family Medicine | 336 N Main St, West Hartford, CT 06117-2675 | 2014-05-14 |
| 1255517249 | Igor Samegulin | Family Medicine | 74 Park Rd, West Hartford, CT 06119-1853 | 2008-01-21 |
| 1801071758 | J. Michael Herr Do LLC | Family Medicine | 45 S Main St, Suite 212, West Hartford, CT 06107-2402 | 2008-01-09 |
| Find all providers in WEST HARTFORD | ||||
| City | WEST HARTFORD |
| Zip Code | 06107 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.